HOW IS BROMISM TREATED?
The treatment of bromism involves preventing further exposure to bromide and promoting bromide excretion. Bromide has a long half-life (10 to 12 days), but in patients with normal renal function, it is possible to reduce this half-life to approximately three days with hydration and diuresis with sodium chloride.3
Alternatively, in patients with impaired renal function or severe intoxication, hemodialysis has been used effectively.5
CASE CONCLUSION
The patient was admitted for observation and treated with IV sodium chloride. After consultation with his neurologist, he was discharged home in the care of his parents, who were advised to continue him on sodium bromide (185 mg bid, orally) since his seizures were refractory to other anticonvulsant medications.
REFERENCES
1. Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore). 1977;56(1):38-54.
2. Figge J, Jabor A, Kazda A, Fencl V. Anion gap and hypoalbuminemia. Crit Care Med. 1998;26(11):1807-1810.
3. Vasuyattakul S, Lertpattanasuwan N, Vareesangthip K, et al. A negative anion gap as a clue to diagnose bromide intoxication. Nephron. 1995;69(3):311-313.
4. Yamamoto K, Kobayashi H, Kobayashi T, Murakami S. False hyperchloremia in bromism. J Anesth. 1991;5(1):88-91.
5. Ng YY, Lin WL, Chen TW. Spurious hyperchloremia and decreased anion gap in a patient with dextromethorphan bromide. Am J Nephrol. 1992;12(4):268-270.
